Schur Mathew, Andras Lindsay M, Murgai Rajan, Siddiqui Ali A, Gonsalves Nicholas R, Sponseller Paul D, Emans John B, Vitale Michael G, Skaggs David L
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
Division of Pediatric Orthopaedics, Johns Hopkins Children's Center, 1800 Orleans St, Baltimore, MD 21287, USA.
Spine Deform. 2019 Nov;7(6):985-991. doi: 10.1016/j.jspd.2019.03.003.
Multicenter retrospective review.
To evaluate radiographic outcomes and complication rates of patients treated with distraction based implants and pelvic fixation with either screws (sacral-alar-iliac [SAI] screws or iliac screws) or hooks (S hook iliac fixation).
Multiple options exist for pelvic fixation in distraction-based growing rod systems; however, limited comparative data are available.
Early-onset scoliosis (EOS) patients of all diagnoses with distraction-based implants that had pelvic fixation from 2000 to 2013 were reviewed from two EOS multicenter databases. Patients were divided into two groups by type of pelvic fixation: (1) screw group (SAI screws or iliac screws) or (2) S hooks. Exclusion criteria were as follows: index instrumentation ≥10 years old and follow up <2 years. A total of 153 patients met the inclusion criteria. Mean age at index surgery was 6.1 years (range 1.0-9.9 years) and mean follow-up was 4.9 years.
Pelvic fixation in the 153 patients was as follows: screw group = 42 and S hook group = 111. When comparing patients with >20° of initial pelvic obliquity, the screw group had significantly more correction; mean 26° ± 13° for the screw group versus mean 17° ± 7° in the S hook group (p = .039). There was no significant difference in change in T1-S1 length (40 vs. 39 mm, p = .89) or correction of Cobb angle (30° vs. 24°, p = .24). The total complication rate for the screw group was 14% (6/42) versus 25% (28/111) in the S hook group, though this did not achieve significance (p = .25). The most common complications were device migration (13), implant failure (8), and implant prominence (4) for S hooks and implant failure (3), implant prominence (2), and device migration (1) for the screw group.
In distraction-based growth-friendly constructs, pelvic fixation with screws achieved better correction of pelvic obliquity than S hooks. Complications were almost twice as common with S hooks than screws, though this did not reach statistical significance.
多中心回顾性研究。
评估采用撑开式植入物及使用螺钉（骶髂翼螺钉或髂骨螺钉）或钩子（S形髂骨固定钩）进行骨盆固定治疗的患者的影像学结果及并发症发生率。
在基于撑开技术的生长棒系统中，骨盆固定有多种选择；然而，可获得的比较数据有限。
从两个早发性脊柱侧弯（EOS）多中心数据库中回顾了2000年至2013年期间所有诊断为EOS且采用撑开式植入物并进行骨盆固定的患者。患者按骨盆固定类型分为两组：（1）螺钉组（骶髂翼螺钉或髂骨螺钉）或（2）S形固定钩组。排除标准如下：初次器械植入时年龄≥10岁且随访时间<2年。共有153例患者符合纳入标准。初次手术时的平均年龄为6.1岁（范围1.0 - 9.9岁），平均随访时间为4.9年。
153例患者的骨盆固定情况如下：螺钉组42例，S形固定钩组111例。比较初始骨盆倾斜度>20°的患者时，螺钉组的矫正效果明显更好；螺钉组平均矫正26°±13°，而S形固定钩组平均矫正17°±7°（p = 0.039）。T1 - S1长度变化（40对39 mm，p = 0.89）或Cobb角矫正（30°对24°，p = 0.24）无显著差异。螺钉组的总并发症发生率为14%（6/42），而S形固定钩组为25%（28/111），尽管差异无统计学意义（p = 0.25）。最常见的并发症中，S形固定钩组有器械移位（13例）、植入物失效（8例）和植入物突出（4例），螺钉组有植入物失效（3例）、植入物突出（2例）和器械移位（1例）。
在基于撑开技术的生长友好型结构中，使用螺钉进行骨盆固定比S形固定钩能更好地矫正骨盆倾斜度。S形固定钩的并发症发生率几乎是螺钉的两倍，尽管差异未达到统计学意义。
